AANA journal
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An endotracheal tube designed to reduce nitrous oxide-induced intracuff pressure increases (Mallinckrodt Brandt rediffusion tracheal tube) and its relationship to nitrous oxide exposure was studied. Thirty-two subjects undergoing general anesthesia with endotracheal intubation used either a conventional endotracheal tube (Mallinckrodt Intermediate Hi-Lo) or a nitrous oxide rediffusion endotracheal tube (Mallinckrodt Brandt rediffusion). Intracuff pressures and nitrous oxide concentration were monitored continuously throughout surgery and recorded at 10-minute intervals for 50 minutes. ⋯ Mean nitrous oxide concentration measured near the pilot balloon was 19.57 +/- 15.8 ppm with the conventional tube and 13.0 +/- 20.7 ppm with the rediffusion tube. Mean nitrous oxide concentration measured near the anesthetist's breathing area was 7.57 +/- 5.8 ppm with the conventional tube and 3.57 +/- 3.3 ppm in the rediffusion tube. All nitrous oxide concentration values remained within National Institute for Occupational Safety and Health recommendations (less than 25 ppm) and did not differ significantly between groups.
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Rocuronium is a new nondepolarizing neuromuscular blocking drug. Its onset of action is comparable to that of succinylcholine, with good-to-excellent intubating conditions possible 1 minute after doses two times the ED95 (600 micrograms/kg). The ED95 of rocuronium is essentially the same for children as for adults. ⋯ Rocuronium is readily reversed with conventional doses of cholinesterase-inhibiting drugs. A new agent, rocuronium possesses a very stable cardiovascular profile and a rapid onset of action. It may be useful for rapid sequence intubation without unacceptable delays in the spontaneous recovery of neuromuscular function.
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Subarachnoid injection during a retrobulbar block is a rare complication, requiring prompt recognition and management of life-threatening respiratory and cardiac depression. This case report describes a patient who began to decompensate 2 minutes after receiving a retrobulbar block. Central nervous system symptoms progressed from restlessness and confusion to respiratory arrest and cardiac depression. ⋯ Causes of respiratory arrest and unconsciousness after retrobulbar block include severe anaphylactic reaction, intravascular absorption, a major cardiovascular event, and subarachnoid injection of local anesthetic. The patient's symptoms in the case presented here suggested that the local anesthetic gained access to the cerebrospinal fluid. Anesthetists should be cognizant of the need to monitor and treat serious complications whenever a retrobulbar block is utilized.
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A major part of anesthesia care involves ensuring the safety of the patient. Electrical hazards in the operating room abound. Knowledge of the principles of electricity is an important foundation for promoting a safe and hazard-free environment. This installment of the AANA Journal course deals with issues that have an impact on electrical safety.